When and why do heart problems start in women? Leading cardiologists in Serbia Dr. Jolic and Dr. Mitov speak to FAKTI

A few days ago, the annual 13th Bulgarian Course on Coronary Physiology was held in Borovets with international participation. The forum discussed topics related to the modern treatment of ischemic heart disease - when to place a stent, when to perform a bypass, etc. But what should be known in general about ischemic heart disease… Two of the leading cardiologists in Serbia speak to FAKTI, Dr. Aleksandar Jolic (left, vice president of the Society of Cardiology in Serbia) and Prof. Dr. Vladimir Mitov, Director of the Interventional Cardiology Department at the Zajčar Medical Center.

- Dr. Yolich and Dr. Mitov, ischemic heart disease is among the most common diseases. Why does this happen, what triggers this disease?
- Dr. Alexander Yolich: There are several factors that influence this. Of course, we have genetic inheritance, but lifestyle also has an impact, smoking is also a very important factor. For some, genetic inheritance is more important, for others there is also an element of stress.

- You look at the lifestyle we lead?
- Al. Y.: Yes, it turns out a combination of factors.

- What percentage of the disease can we attribute to the hereditary factor?
- Prof. Dr. Vladimir Mitov: We cannot say that there is any preponderance between the different factors. But I will share something else. Some time ago, when people had a different lifestyle – I mean the lives of our parents, grandparents who worked in the fields, there were not so many patients with ischemic heart disease. Now we have inheritance, we have stress, we have bad habits in life. Let me also pay attention to something else. If you look at the people on the street right now, you will see that there are not many weak people. When we were children, we walked a lot, we rode in cars less, and now this is a way of life. We move a little.

- Currently, our life is on a chair or on the sofa in front of the TV, but with a phone in our hands…
- Al. Y.: And cigarettes, don't forget cigarettes. This is a factor that directly influences the development of atherosclerosis. It has been proven. Cigarettes are a craze today, smoking is fashionable. A few cigarettes, a little inheritance, a little stress and things accumulate. It all depends on the person's physiology. Sometimes the hereditary gene prevails, sometimes there is the environment in which we live, sometimes the harmful habits we have.

- How important is it to catch ischemic heart disease at the beginning, so that adequate treatment can be undertaken, and not when we have a clearly expressed disease?
- Vl. M.: A lot depends on whether we are talking about a man or a woman.

- Why? It is generally known that women's bodies are stronger…
- Vl. M.: In women, we are talking about the development of ischemic heart disease later. And this is because the menstrual cycle plays a role in women. In women, the hormones that are secreted in her body have a very different effect. And it is precisely the hormones in her body that protect her body from atherosclerosis. That is why in women we are talking about ischemic heart disease in later years.

- You mean when the lady goes through menopause and then the problems begin. Right!
- Vl. M.: Yes, then blood pressure problems begin, then cardiovascular problems begin. In men, we can talk about atherosclerosis after they turn 40. While in women after 55, 60 years.
- Al. Y.: It has already been proven that in men we are talking about these problems after 40 years, and in women, as my colleague mentioned, after 55, 60 years.
- Vl. M.: There is also something else that is very important to say. And this is whether the person has concomitant diseases, because we can define diabetes as the main mechanism for the development of heart disease. Diabetes simply multiplies the risk of developing atherosclerosis.

- And why are more and more young people - we are talking about 30+ years old, experiencing a heart attack?
- Al. Y.: It is difficult to say why, but most likely it is either hereditary, or it is the stress of life, or for example, if he started smoking very early, because this is a very significant factor, if we have early diabetes too. Here, everything can still be a combination of factors that predetermine this.
- Vl. M.: There is also something else that we observe in young people who have heart attacks. And we establish this when conducting a coronary angiography. What does it turn out to be? We see that the person has a problem, and the examination shows that his heart vessels are clean. There are no clogged blood vessels, no atherosclerosis … Then? Stress! Experiencing severe stress can cause spasm of the heart vessels and a heart attack occurs. And this is again a consequence of the life we lead. We are to blame for everything. Therefore, more movement and less tension.

- People with heart problems and sports. Is it possible, how, how much…
- Al. Y.: For people with heart problems, movement is very important, but in moderation. If we talk about sports as a replacement for physical activity, which our grandparents had, because they were in the fields, let's say not so much active sports as physical activity.
- Vl . M.: However, when we talk about sports, let's differentiate things, because we have professional sports - which is another topic, and sports for personal pleasure. It is important for people to know that we need 150 minutes of active movement per week. We can spread it out 30 minutes a day, for example, and in this way we prevent atherosclerosis.

- And sports and people who have experienced a heart attack, have a stent or bypass. How should they approach it?
- Vl .M.: This is completely different, because in such people we already have a proven disease, we have something established, we have some treatment and now it all depends on what kind of load they will be subjected to. Usually these people have a different way and lifestyle that they lead. If we are talking about sports for such people, it is really another topic, because they need to have a sports regimen that will be different from that of a healthy person.
- Al. Y.: It is also very important what kind of sport we are talking about. There are sports with great physical activity, there are those that do not require much exertion. If someone wants to swim 5 km a day, ride a bike 20 km, etc. These are things that are not good for a person with heart problems. For a healthy person, going up Musala is not a problem, but for people who have had a heart attack, who have a bypass, it is good for them to have physical activity, but not with much exertion. It is important and good to replace the car with walking.
- Vl. M.: This is useful for all people, not just those who have heart problems.